Prakasini Satapathy, Abhay M. Gaidhane, Nasir Vadia, Soumya V. Menon, Kattela Chennakesavulu, Rajashree Panigrahi, Sanjit Sah, Suraj Tiwari, S. Govinda Rao, Khang Wen Goh, Rachana Mehta, Muhammed Shabil, Mahendra Singh, Ganesh Bushi
Background: Mpox, caused by the monkeypox virus (MPXV), is primarily recognized for its dermatologic and systemic symptoms. However, emerging evidence suggests a significant prevalence of gastrointestinal (GI) manifestations, particularly proctitis, diarrhea, nausea, vomiting, and abdominal pain. Despite the growing clinical recognition of these symptoms, their epidemiology and impact remain poorly understood. This systematic review and meta-analysis aim to quantify the prevalence of GI manifestations in Mpox patients and assess their clinical significance. Methods: A systematic review following PRISMA guidelines was conducted across PubMed, Embase, and Web of Science, including quantitative studies published up until October 2024 that reported GI manifestations in Mpox patients. Screening and data extraction were performed using Nested Knowledge software, and study quality was assessed using the Newcastle–Ottawa Scale. Meta-analysis was conducted using R version 4.4, with heterogeneity evaluated via the I2 statistic. Sensitivity analyses and publication bias were assessed using Doi plots and the Luis Furuya-Kanamori (LFK) index. Results: Out of 1229 records, 33 studies met the eligibility criteria, yielding a pooled prevalence of proctitis in Mpox patients at 24.75% (95% CI: 18.93%–31.04%) across 5878 participants, with high heterogeneity (I2 = 94.8%). The prediction interval for proctitis ranged from 1.46% to 61.76%. The pooled prevalence of other GI manifestations was 30.45% (95% CI: 18.27%–44.14%) across 2237 participants, with significant heterogeneity (I2 = 95.2%) and a prediction interval ranging from 0.00% to 85.28%. Sensitivity analyses confirmed the stability of these estimates, while publication bias was indicated by LFK index values exceeding 2.77. Conclusions: This meta-analysis highlights the substantial burden of GI manifestations in Mpox, particularly proctitis, with considerable variability across studies. The findings underscore the need for standardized diagnostic criteria and increased clinical recognition of GI symptoms in Mpox management. Further research into the underlying pathophysiology and integrating GI symptom assessment into Mpox surveillance and treatment strategies could enhance diagnostic accuracy and patient care outcomes. © 2025 The Author(s). JGH Open published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.
Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India; Faculty of Data Science and Information Technology, INTI International University, Nilai, Malaysia; Jawaharlal Nehru Medical College, and Global Health Academy, School of Epidemiology and Public Health, Datta Meghe Institute of Higher Education, Wardha, India; Department of Pharmaceutical Sciences, Marwadi University Research Center, Faculty of Health Sciences, Marwadi University, Gujarat, Rajkot, India; Department of Chemistry and Biochemistry, School of Sciences, JAIN (Deemed to Be University), Karnataka, Bangalore, India; Department of Chemistry, Sathyabama Institute of Science and Technology, Tamil Nadu, Chennai, India; Department of Microbiology, IMS and SUM Hospital, Siksha ‘O’ Anusandhan (Deemed to Be University), Odisha, Bhubaneswar, India; Department of Paediatrics, Dr. D. Y. Patil Medical College Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed-to-Be-University), Maharashtra, Pune, India; Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth (Deemed-to-Be-University), Maharashtra, Pune, India; SR Sanjeevani Hospital, Siraha, Nepal; Centre for Research Impact and Outcome, Chitkara University Institute of Engineering and Technology, Chitkara University, Punjab, Rajpura, India; Division of Research and Innovation, Uttaranchal University, Dehradun, India; Department of Data Science, Gokaraju Rangaraju Institute of Engineering and Technology, Telangana, Hyderabad, India; Faculty of Mathematics and Natural Sciences, Universitas Negeri Padang, Padang, Indonesia; Clinical Microbiology, RDC, Manav Rachna International Institute of Research and Studies, Haryana, Faridabad, India; University Center for Research and Development, Chandigarh University, Punjab, Mohali, India; Medical Laboratories Techniques Department, AL-Mustaqbal University, Babil, Hillah, Iraq; Department of Biotechnology, Graphic Era (Deemed to Be University), Dehradun, India; Graphic Era Hill University, Dehradun, India; School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, India
